Living in the northwest it’s easy to forget the sun exists during the winter. Most days are dim, usually drizzly and almost always cloud-covered. It’s easy to remember to take care of your skin when your arms and legs are playing in the warm rays of the sun but when you’re bundled under scarves and rainwear, our self-care falters. We care for our children’s skin often better than our own. Winter brings a slew of skin harms with it. Giving your skin the TLC it needs during these dark months will keep it healthy (and looking great) once it’s time again for spring exposure.
Dry Skin And “The Itch That Rashes”
Our skin gets dry in the winter for a variety of reasons. Cold temperatures, lack of humidity and recirculated air (hello office heater!) can all contribute to dry, scaly spots. Winter is also a time when we see an increased risk for eczema flare-ups, a chronic, relapsing condition that brings incredibly dry, itchy patches of skin. The icing on the cake is that eczema primarily affects kids! A recent study suggests at least 10% of children in the US suffer from eczema, the “rash that itches.” A patch gets started, a child can’t help but itch it and the rash blooms. Between 2000 & 2010 pediatric cases of eczema came close to doubling and while this condition not only affects how skin looks and feels, it can have a direct impact on a child’s quality of life. Nearly half of kids with eczema report a severely negative impact on their quality of life, including sleep deprivation (from the itching), activity restriction and even depression. If your child suffers from eczema, talk to your pediatrician to create an action plan for combating these dry months and hopefully avoiding such severe tolls and trolls on everyday life.
Protecting Your Skin Year Round
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Image courtesy: American Dental Association
Oral health doesn’t start and end with the dentist. Times are changing as the Washington Dental Service Foundation has trained 1,600 pediatricians and family physicians throughout the state on the importance of oral hygiene in young children. Pediatricians are now applying fluoride during well-child check-ups and counseling families more comprehensively on how to prevent dental decay while also referring to dentists for prevention and acute dental problems. Just last month I attended the 1-1/2 hour oral health training with a pediatric dentist. That learning coupled with a new policy statement from The American Academy of Pediatrics highlighting the importance of oral health inspired me to get the word out. I suspect we can all do a bit better protecting our children’s mouths. Recommendations for fluoridated toothpaste have recently changed (use it with the very first baby tooth!) as has knowledge and reminders about how we share our bacteria with our children. What we do for our mouth may have direct effects on our children’s.
The Most Common Chronic Childhood Disease
- The facts about oral health in children are a little surprising. By their first birthday 8% of toddlers have cavities in their mouth and the Pediatrics policy detailed 24% 2-4 year-olds, 53% 6-8 year-olds and 56% 15 year-olds also have dental disease. Since oral health (even in babies and toddlers) is an integral part of overall health of children this is problematic. Dental disease has strong links between diabetes, respiratory infections and heart disease. The numbers for children with dental disease are high (!!) which makes dental disease the most common infection of childhood.
- Good news is much of this disease can be prevented (or corrected) and because infants and young children see the pediatrician more frequently than the dentist, it’s becoming clear that pediatricians need to hone skills on oral health, the disease process, prevention and dentist interventions when necessary.
4 Things I Learned About Oral Health
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This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them.
Soccer is the highest risk sport for school-age girls.
What Happens During A Concussion?
A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain, resulting in a mismatch where the brain needs more energy but receives decreased blood flow to the brain temporarily. This mismatch in blood flow is believed to last up to 10 days following an injury and helps explain the symptoms associated with a time-limited injury such as a concussion.
Unfortunately this also explains why diagnosing and managing concussions can be vexing. Unlike a broken bone, we do not have validated imagining or blood tests that enable definitive diagnosis. The best practice of diagnosing concussion currently relies on obtaining a detailed history and physical following an injury. Depending on the severity of the injury and initial presentation, a sideline assessment should performed to look for common post-concussive symptoms. If the initial injury is more severe one may need to be evaluated in the emergency department and imaging may be obtained to help rule out a more severe injury. Each traumatic brain injury is unique, and should be treated with respect. There is nothing more heart breaking than a traumatic injury being improperly respected and identified, leading to a delay in care and permanent deficits.
It can be challenging to determine which concussions are mild, severe and which may progress. Ultimately the goal is to prevent injuries, screen for potential head injuries when appropriate and diagnose and treat injuries in a timely fashion to limit their severity.
How To Prevent Head Injuries
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J. Forrest Bennett, ARNP, Rehabilitation
This is a guest post from J. Forrest Bennett, an ARNP at Seattle Children’s and Dr Samuel Browd (@DrBrowd) a neurosurgeon who, together with their team, care for children after concussions. Clearly, we’ve all heard more about concussion these past few years. Not just because of pro-football tragedies and lawsuits but also because of the increasing expertise the medical community is acquiring around how to care for children and young adults after getting hit in the head. We’re also learning how to prevent head injuries in the first place. Forrest and I first started discussing this last spring when I began to see his passion in getting great information out to families. He’s convinced the more we parents (and community physicians) know about what to do with head injuries the less children suffer. In some cases what we do in minute 1 or day 1 after an injury can really change how a child recovers. Take a peek at this awesome post and please post comments/questions if you have them. More content will also be published later this week.
There is an ongoing debate about how we should best assess, manage and prevent head injuries in sports. Given the complexity of the injury and the effects that a concussion can have on an individual there is no room for the outdated and dismissive terms such as “getting your bell rung” or a “ding to the head.” Being dismissive of head injuries can lead to premature return to play and can end tragically. These injuries really matter.
This isn’t to say that kids shouldn’t play sports of course. Sports promote cardiovascular health and play a crucial role in the character development of children and adolescents. Parents must balance the risk with the benefits of sports to promote healthy decision-making. I like to talk about an active risk-reduction lifestyle. Through outreach and education we can prevent debilitating injuries, identify concussions early, and provide care plans that stem from evidence to limit the impact injuries have on kids.
What Every Parent Should Know About Concussions
- Helmets do NOT protect against all concussions
- Helmets provide crucial protection against skull fractures and more severe brain injuries but you can still suffer a concussion even with all of the proper protective equipment.
- There is a right way to play sports
- Teach your kids safe ways to play sports and adhere to the rules of the game. For example: no tackling in soccer and no head tohead contact in football. HEADS UP trained coaches teach actively safe participation in sports.
- The majority of sport rules are intended to maintain a level playing field and enjoyable experience. Head to head contact in football is just one example of improper and unsafe play that has recently drawn national attention in increasing ones risk for injury.
Because injuries happen, a group of experts developed the Standardized Concussion Assessment tool- 3rd edition (SCAT 3). This tool can help guide trained coaching staff, athletic trainers and medical providers in the initial assessment, triaging, and monitoring of these injuries. Many concussions can be handled through the expertise of your pediatrician or primary care provider. Concussions with prolonged symptoms (lasting weeks to months) and\or more severe injuries frequently benefit from a team approach. Read full post »
Antibiotic resistance is like global warming; it feels like it’s someone else’s problem to solve and much bigger than all of us. Yet the simple choices we make – whether or not to use antibiotics and which ones we pick – do affect us and our community. ~Dr Matthew Kronman
This week is Get SMART About Antibiotics Week, aimed at raising awareness of antibiotic resistance and the importance of appropriate use. Dr Kronman’s “inconvenient truth” reminder serves up the importance of our choices; what we do everyday with our food and our medicines changes not only our own health but also the health of others now and in the future. Antibiotics in food, water, and our clinics and hospitals change our environment. Each dose of antibiotics given to our children, ourselves, or the animals we eat change our community’s health in general. The more we use antibiotics that kill off susceptible bacteria, the more we select bacteria for survival that are resistant to known treatments. The consequence over time for us all is that there are more resistant bacteria or “superbugs” around causing harder to treat infections.
4 Things You Can Do Today To Avoid Excess Antibiotics
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There’s a decent amount of confusion when it comes to the decision to give our children vitamins and supplements. Store shelves (real or virtual) are filled with tinctures and gummies marketed towards children. And you’ve likely heard that, in general, pediatricians don’t recommend vitamins for children who eat a “normal” diet. There are exceptions to every rule (see below, especially as it pertains to vitamin D) but the bottom line is that supplemental multi-vitamins are not an essential part of a child’s diet. If your child eats a rainbow of foods, it’s unlikely they need pile of additional minerals and vitamins in pill form.
4 Things To Know About Children And Vitamins
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It’s Flu “shot” season but thankfully not every vaccine hurts going in. This year your child may be offered either the “flu shot” or the flu nasal spray vaccine (ouchless!). This year most nurses and docs will encourage young children to get a nasal flu spray over the shot as recent data has found the nasal flu vaccine protects younger children better. Every year the flu vaccine is created to protect against influenza viruses predicted to spread and circulate in North America. We need the shot every year for two main reasons:
- Typically, different influenza virus circulate around the world from year to year. Over 100 international centers maintain year-round surveillance to determine and predict which strain will cause human infections. The information is used to forecast the recipe for the vaccine here at home. This year the strains (types) of influenza in the shot and nasal spray are the same as last year (2013-2014).
- Protection Fades. When you get a flu vaccine you stimulate the immune system to create protection against the strains of the virus in the vaccine. That immunity (the antibodies that are created) tends to fade and wane in your bloodstream after about 6-12 months. Therefore, even if you got the flu vaccine last year you really want your family to have it again this year so it protects you through the winter influenza season which can continue late into the springtime but tends to peak in February or March.
The flu vaccine contains either three (trivalent) or four (quadrivalent) strains of influenza. There is no official recommendation for one over the other. Flu vaccine is recommended for all children over 6 months of age who have no contraindication to the vaccine.
Worth noting: If the thought of needles deters you from getting the vaccine for your child or your family, Live Attenuated Influenza Vaccine (LAIV), a nasal spray, is a great option for those age 2 to 49 years. In fact, there’s data to suggest the nasal flu vaccine is more effective in protecting children from influenza in young childhood. Recommendations this year include a push to have children between 2 and 8 years of age immunized with the nasal spray whenever possible. If the nasal isn’t available, the shot should be given — no reason to wait.
About 20,000 children younger than 5 years old are hospitalized from flu every year — form CDC “Which Flu Vaccine Should Children 2 to 8 Years Old Get?”
Who Can Get The Nasal Flu Vaccine?
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Tonight, after President Obama speaks, PBS airs a NOVA documentary about vaccine science and safety. Vaccines: Calling The Shots. It’s told through the parent, pediatrician, and community lens. If you’ve ever wondered about vaccines in America, it’s time to tune in. I’ve been in touch with the team producing this documentary. Seriously excited to hear this story unfold tonight.
(update Sept 11: watch Calling The Shots online)
I think this is a big deal. This is an investigation on the science of vaccines.
The less the disease exists, the safer I am.
It’s a balancing act. The risks happen to be minuscule… the benefits are enormous
If inclined, follow a team of parents, pediatricians, and communities tonight on Twitter while it airs: #vaccinesNOVA
I take solace sometimes knowing I can’t stop time. When I look to the clock and trade panic for solace it’s a way to distance myself from the reality that as time marches on in its infinite human construction, I don’t have to think about moments with the boys lost. Every parent hears over and over again that, “it just goes so fast.” I find that advice never helps. Just makes us feel like time with our beloved little humans is slipping through our fingers and I can’t imagine a parent who feels good about that.
My little boy is no longer allowed to be entirely in my grasp as the doors of that big schoolhouse open forever next week. My 5 year-old starts Kindergarten and it’s pretty clear to me that from here forward there will be many forces facilitating his gradual exploration of the world away from our cozy nest.
The solace I mention is real though and it helps me. At moments I can feel the space and peace that comes in knowing I have literally no control over his aging and what it provides — like giving into the wind I can lean into this space and know what a privilege it is to witness this wild ride. It certainly helps that he clearly loves the speed with which life is hurling at him. I see it in moments where he looks at the Kindergarten class list and in the moments where he sticks his right foot out while standing next to his bike and poses as if he’s ready to take a big stage and I feel his thrill as he looks over to his older brother and realizes he finally belongs at the same school. Growing up really is quite a thing to behold.
Being a part of something bigger is a huge part of being human and school is an essential first (or second) step
And although that solace I just mentioned is real I can’t help but tell you that there is certainly a part of me that suffers in these waning summer days. I feel the excitement yes, I lean into the solace yes, but as a working mom I can’t help wonder, “did I do this all right?” Were the last 5 and 1/2 years exactly what I imagined for his time at home preparing for the onslaught of schooling? Was I present, available, ready, and everything I wanted to be? Well, surely not. It’s clear my iPhone got in the way, as did my job, and my ambition to improve children’s health. Thankfully there are ways he shows me he knows he’s got my attention but I can’t help but trip (and fall) sometimes knowing there are infinite ways to raise a child and I do look at those other paths with curiosity.
Today let me tell you this: I’ll hold onto the solace every single moment I see it and I’ll let it mix up with the suffering. I can gently mute the parts of pain that comes with aging and losing the intimacy found between mother and son during toddlerhood and the preschool years. I’ll find that solace when I feel the thrill from peering over the edge of this great big world ahead of him. One thing I know for certain is I’ll enjoy the first moments of Kindergarten next week, too. This little boy of mine is growing up to be a thoughtful, curious, kind, and happy little man. It’s his excitement for the next giant step that will tug me along into September…
Sometimes it can feel that a career of crafting prevention messages can be snuffed out in a moment. Every once and a while this work in media/messaging can take my breath away, for all the wrong reasons. Today, I realize my work educating parents and children about sunscreen use, UV radiation, aging, and skin cancer risks may pale in comparison to the potential power of a single quote on the side of a shopping bag. I mean, how can I compete with a company that sold $1.6B of merchandise last year and likely distributes tens to hundreds of thousands of reusable bags around North America everyday? Shopping bags have the luxury to walk around for years and tuck into peoples lives in remarkably intimate ways. Even I use these bags (or used to) to carry my lunch on a daily basis. It wasn’t until yesterday that I realized I’d been carrying my lunch around in a bag that goes, in part, against my entire mission. When I read about recent dermatologist outrage for Lululemon bag quotes I literally turned my head to my kitchen counter (see photo) and there sat my lunch bag on my counter just staring at me. Under the tote’s handle was the devious myth, “Sunscreen absorbed into the skin might be worse for you than sunshine. Get the right amount of sunshine.”
Now, that’s not true. In fact there is no “right” amount of sunshine and absorption concerns for sunscreen haven’t proved more dangerous than sunshine. Also, absorption varies with age and body site, here I review information about why to use physical sunscreens (and sun protective clothing) in infants when possible to reduce any risk from ingredient absorption because of their more immature barrier. That being said, I’d always recommend sunscreen over sun exposure for infants and children. The conversation about getting sunshine is centered around getting enough vitamin D. Although minutes (not hours!) in the sun provides vitamin D, we can safely get vitamin D entirely from the food we eat or a daily supplement (all children are recommended to have at least 400 IU Vita D daily). We don’t need to consume sun. In fact all sun exposure comes with UV radiation that contributes to mole production, aging, and skin cancers– even the most deadly kind, malignant melanoma. Sun protection keeps skin looking beautiful (prevents aging) and prevents skin from discoloration and cellular/immune changes that can lead to cancer. Sun-protective clothing, seeking shade, and sunscreen are our best bets for beautiful, healthy skin. Read full post »